Provider Demographics
NPI:1265227342
Name:WHITTUM, BREANNA ROSE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:ROSE
Last Name:WHITTUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W PERRY ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2033
Mailing Address - Country:US
Mailing Address - Phone:567-395-4212
Mailing Address - Fax:
Practice Address - Street 1:318 W PERRY ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2033
Practice Address - Country:US
Practice Address - Phone:567-395-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver